PL-16-2134 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL 1
Phone: (305)795-2204 Fax:(305)756-8972
Inspection Number. INSP-264382 Permit Number: PL-7-16-2134
Scheduled Inspection Date: November 28,2016 Permit Type: Plumbing - Residential
Inspector: Hernandez,Rafael
Inspection Type: Final
Owner. DE BRUMN,GERALD&ANABEL Work Classification: Addition/Alteration
Job Address:812 NE 92 Street
Miami Shores,FL 33138-
Phone Number (305)299-7252
Parcel Number 1132060050190
Project: <NONE>
Contractor. TITAN PLUMBING REPAIR LLC Phone: (786)487-9288
Building Department Comments
REMOVAL AND REPLACEMENT OF KITCHEN SINK, Infractio Passed Comments
FAUCET,AND DISHWASHER. INSTALLATION ON NEW INSPECTOR COMMENTS False
KITCHEN SINK, FAUCET,AND DISHWASHER.
Inspector Comments
Passed
Failed
Correction a
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
s ° o Miami Shores Village ` � yt pm�in ReSide �`
10050 N.E.2nd Avenue NE
F
c+ �!� ,I�lOrki�'�i�l .� ���t@1"��'►rlt;, .
Miami Shores,FL 33138-0000
Phone: (305)795-2204oft
tt7l201 Expiration: 03/06/2017
Project Address Parcel Number Applicant
812 NE 92 Street 1132060050190
GERALD&ANABEL DE BRUIJN
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone cell
GERALD&ANABEL DE BRUIJN 812 NE 92 Street (305)299-7252
MIAMI SHORES FL 33138-
812 NE 92 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 1,050.00
TITAN PLUMBING REPAIR LLC (786)487-9288
Total Sq Feet: 0
Type of Work:REMOVAL AND REPLACEMENT OF KITCHEN Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:3 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20 Invoice# PL-7-16-60795
DBPR Fee $2'25 09/07/2016 Cash $ 116.70 $50.00
DCA Fee $2.25
Education Surcharge $0.40 07/29/2016 Check*114 $50.00 $0.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $1.60
Total: $166.70
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated.
September 07,2016
Authorized Signature:Owner V A plicant / Contractor / Agent Date
Building Department Copy
September 07,2016 1
Miami Shores Village ��
WQ��' Building Department J 29 2016
10050 N.E.2nd Avenue,Miami Shores, Florida 33138
L
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC201 �
BUILDING Master Permit No. Q 2/3�
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑•PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
rr
S'Ly CONTRACTOR DRAWINGS
JOB ADDRESS: '91 Nt ��
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: ����� � "' �� Is the Building Historically Designated:Yes NO
OccupancyType:Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): y 51?=m Phone#: ---1&;2-
Address:
Address: 2 N
City: Mt 11AIGS State: Zip: 221
Tenant/Lessee Name: / Phone#:
Email: C? 1 �� T�D �"➢ )
CONTRACTOR:Company Name:-'C i A� ��lAN1' te��(-� a?Pc�� ice_ Phone#: — 664%-7(2.6�*
Address: I CI S %4,"E SCS C0" g'� —
City: State: CLIA P ZIP: 3 6(�
Qualifier Name: Ni r4 U10*,A 1E_Z— Phone#:
State Certification or Registration#: Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ _o Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New [�Repair/Replace ❑ Demolition
Description of Work: Yn&Et 'j\/1PN1_ Alii ) at�kL4�'Z MJZ;!!! � 6T-- `X- T Cr1 t4 Sa t4 r_,
"F:7PvXA C%45'V_ tate? T?;S►�rW� `l�-E.� -t���e - Imo➢ ON K'CW
Specify color off(color thru tile:
Submittal Fee$ cJV Permit Fee$ C, CCF$ 1 1—® CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ / ` Training/Education Fee$ C3- YO Double Fee$ A
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES,BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
�\y
Signature Signature
OWNER or AAT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of To v 20 1(0 , by 1M day of �i� 20 /4 by
Q O� who is personally known to 4who is personally known to
me or who has produced 12L, Dt62 —Zll '7? /-0 as m=who has produce as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: �, � W NOTARY PUBLIC:
r
Sign: ✓' V wil— Sign:
Print: Print:
KELLY J VILLA
_
Seal: _- ';Y ���IION 3t EE 878455 Seal: ILL.y��'"
'.� EXPIRES Feb►uary 26,2017 ;A, .fro g ���
!• ,q MV C®AdI 11gMN 8 BE 878455
l ?1 ' v ..r •. �tl''9- EXPIRES F®biuery 28,2017
APPROVED BY nv s Plans Examiner Zoning
--7
Structural Review Clerk
(Revised02/24/2014)
fops Miamishores 'Vwillage
Building Department
ua'Ri�
10050 N.E.2,nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax:(305) 756.8972
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. •/ OPY OF QUALIFIER'S STATE LICENCES
B._ ZCOPY OF LOCAL L B USINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE*
D. COPY OF WORKERS COMPENSATION INSURANCE*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E_ COPY OF WORKERS COMPENSATION tNSURANC-E*
(Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
*YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES,FL 33138
Certificate must specify the description of operations or contractor license number.
s■rorrr■rrrrrr■rrrrrrrsrrrrrrsrrrrrrrrerrrrrrrrrrrrrrrrrrrrrrreearrrrrrrrrrrrrrrrrrrrrrrrerr
BUSINESS NAME: 'T T 1--%JkC1Z%"4 C
BUSINESS ADDRESS: 11-1 -S 1-40 1 OR�S\uet- c TY mwPok STATE 'FLP� ZIP :3 31 Bei
BUSINESS PHONE: FAX NUMBER(T
CELL PHONE(17P QUALIFIER'S NAME: A24-td Cr® iE`Z
QUALIFIER'S LIC NUMBER: t✓J:-r G 14-a q 519
STATE OF FLORIDA
_. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
GOMEZ,AARON
TITAN PLUMBING REPAIR LLC
1175 NE 109TH STREET
MIAMI FL 33161
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and STATE OF FLORIDA
Professional Regulation. Our professionals and businesses range n
from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND
restaurants,and they keep Florida's economy strong. ^,�..rr' PROFESSIONAL OF,
Every day we work to improve the way w2 do business in order CFC1429519 ISSUED:. 02/23/2016
to serve you better. For information about our services, please
to onto www.myfloridalicense.com. There you can find more CERTIFIED PLUM8iNG-0ONTRAG`rOR
information about our divisions and the regulations that impact GOMEZ,AARON
you, subscribe to department newsletters and learn more about TITAN PLUMBING REPAIR LL4 F�
the Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate
Fairly.We constantly strive to serve you better so that you can IS CERTIFIED under the provisions of Ch.489 FS.
serve your customers. Thank you for doing business in Florida, Expiration date :AUG 31,2016 L1602230001193
and congratulations on your new license!
DETACH HERE
RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
MIR
CFC1429519
The PLUMBING CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
GOMEZ,AARON
TITAN PLUMBING REPAIR=LLc
1175 NE 109TH STREET`"' "''°
MIAMI FIL 33161-
lL ■ ■
Jh N 1/11•■
11—1 M r%%/I A1AI [^C/1 46 1 1Cfl77Znnni i ai
Local Business Tax Receipt
Miami—Dade County, State of Florida
—THIS IS NOT A BILL—DO NOT PAY LBT
7198195
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
TITAN PLUMBING REPAIR NEW BUSINESS SEPTEMBER 30, 2016
1175 NE 109 ST 7480618
MIAMI, FL 33161 Must be displayed at place of business
Pursuant to County Code
Chapter 8A—Art.9&10
SEC.TYPE OF BUSINESS
a OWNER PAYMENT RECEIVED
TITAN PLUMBING REPAIR LLC 196 PLUMBING BY TAX COLLECTOR
C/O AARON GOMEZ MGR CONTRACTOR 75.00 02/29/2016
Worker(s) 1 CFC1429519 CREDITCARD-16-025281
This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license,
permit,or a certification of the holders qualifications,to do business.Holder must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business.
The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a-276.
MIAMFDADE>- For more information,visit www.miamidade.novltexcollecto
rr
4
,.---i �
�Q
CERTIFICATE OF LIABILITY INSURANCE �'
5%1!%LU1b
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(St AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. N SUBROGATION IS WAIVED, subject to
the terms and conditions of the Policy,certain policies may require an endorsement. A statement on tits certificate does not confer rights to the
certificate holder In lieu of such endors s.
PROM)M comrDavid Bilu
Rick Gibbs, P.A. Insurance Agency PNo (954)581-7740 F ;E9S4)584-9875
1000 S. State Road 7
INSURE KS)AFFOFMW COVE RAGE taw#
Plantation FL 33317
INstrreo II�URERA Zndurance
B:Granada Insurance
Titan Plumbing Repair LLC
mviREFtc Amtrust North America
1175 NE 109 St ItvsURERn
INSUIMR E'
Miami FL 33161 IRF:
COVERAGES CERTIFICATE NUMBER:CL15123003431 REVISION NUMBER:
(HIS 15 10 CtR11FY THAI IHE K)LK;IES Of INSURANCE LISItU BtLOW HAVt BttIY WSUEU IU (Ht INSURED IYAMW A80Yt KW IHVle(JLK:T PERM
INDICATED. NOIVWHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH1CH THIS
CERTIFICATE MAY ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS ABJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF DANCE POLICY NUMBER POUCY EFF UMRS
X I COMME11tCIAL GENAL UAB1rrY EACH OCCURRENCE $ 1,000,000
A CLAIMS hflADE OCCUR PREMISES ffy aocw $ 100,OOO
CBC20000460901 5/8/2016 $/8/2017 ME[)EXP{AW ompwwn) $ 5,000
:j PERSONAL&ADV(JURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY Q JELOG
PRODUCTS-COMPfOP AGG $ --i-10041000
OTHER: EnVoyse Beness
AiJTOMOSILE UABILfrY Ea $
B ANY AUTO BODILY INJURY(Per person) $ 10,000
�
O$ AU OS OIIOFW0024918 5/7/2016 5/7/2017 BODILY INJURY(Per socidert) $ 50,000
HIRED AUTOS NON-OVVNEDAMAGE
AUTOS p�acade� $ 50,000
5
t!l LA UASOCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS-MAS AGGREGATE $
DED RETENTION $
WORmtERS COMPENSATION
AND EMPLOYERS'LIAB9 ftY STATUTE
PROPRIErORIPARTNEIWEXECUT IVE y{N E.L.EACHUTE I E
DTH-
ANY
PET
OFRCER1MEME3ER EXCLUDED? F]NIA $ 500,000
C
(Maft tory In I" THCSS16973 12/112015 1211/2016 E.L.DISEASE-EAEb9PLOY $ 500 tr00
If s describe mer
iJESL�REPT�N OF OPERATIONS below E.L.DISEASE-POLICY LIMFr $ 500 000
DESCRIPTION OF OPERAMONSI LOCATIONS I VE NCLES(ACORD 101,Addidwrel Remeks Sdodule,maybe athwhad H more space is required)
Plumbing Contractor
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
iais�.ni C�IIOL'6S V11lr3gC Building rmpi; THE WA—MON MA7'M 7HSRE mOTM WL, Soa tAyEpMs arum
10050 HE 2nd Ave ACCORDANCE WETH THE PAY PROVI>NOHB
Hdami Shores, 1% 33138
AUTHOR REPTATIVE
D Boatwright/DA`dIDB
' ^ 0 9888-2014 ACORD CORPORATION, All rights reserved.
ACORD 25(201 The ACORD name and logo are registered marks of ACORD
INS025 poi,4o1)